September 24, 2017

Now that effective cures and treatments have been developed for Hepatitis C and HIV, Dr. Mamta Jain is working to solve the next major challenge: getting the drugs to the people who need them. It's harder than you might think.

By Kaulie LewisPopulation Health ScholarUniversity of Texas SystemMaster's Student in JournalismUT Austin Moody College of Communication

When Dr. Mamta Jain first entered the infectious disease field, she worked with viruses that were jointly responsible for tens of thousands of deaths a year.

For patients with HIV and Hepatitis C, both focuses of Jain’s research from 1999 to the present, there were once no appealing treatment options. Though early interferon therapy was available for Hepatitis C during the late ‘90s, it wasn’t particularly effective and often came with debilitating side effects. Combination anti-retroviral therapy for HIV had just been introduced. Only a few years before, HIV/AIDS had been the leading cause of death for adults 25 to 44.

In the years since Jain entered the field, things have changed dramatically for both diseases.

For Hepatitis C, the evolution has been similarly dramatic. It’s now highly curable, with new treatments proving to be up to 90 percent effective.

That’s not to say that these viruses are no longer health concerns, only that the focus of medical research and investment is changing, particularly for Hepatitis C. The virus was responsible for more deaths than HIV during the late 2000s, but there is now a highly effective cure available for the virus, so the challenge isn’t to develop new treatment approaches. Rather, the ongoing health disparities for Hepatitis C patients reflect the challenges of connecting those patients to treatment.

“The big thing now is getting treatment out to the population that needs this,” says Jain. “Before we were trying to figure out what treatments had the best efficacy. Now it’s getting the drugs to the people. We’re at that implementation stage.”

The phrase “implementation stage” may suggest a straightforward process: simply take new, highly effective drugs, and provide them to those who need them most.

Except, of course, it’s much more complicated than that. Many of those infected with Hepatitis C don’t know they have the virus – baby boomers who contracted it from contaminated blood transfusions before the mid-90s, for example – and others aren’t aware of the serious long-term effects of the infection, which can lead to cirrhosis, liver disease, and certain cancers. Once identified, Hepatitis C patients must navigate their way through the labyrinth of the American healthcare system in order to locate providers trained to test and treat them. They also have to find the funding necessary for massively expensive medication and cures.

Navigating this system often frustrates patients at all levels, but it’s particularly trying for under-insured or uninsured patients and for those struggling with poverty, low literacy, or histories of substance abuse and mental illness. As the public safety net hospital serving Dallas County, the Parkland Hospital system is tasked with caring for these patients, and it’s a cause that Jain and her colleagues champion throughout their work. Much of Jain’s research is concentrated on the effectiveness of patient navigation systems for HIV and Hepatitis C patients, and navigation assistance is a foundational piece of many of her projects.

These projects include a program at Parkland Hospital, funded by the Cancer Prevention Research Institute of Texas (CPRIT), that incorporates electronic medical record (EMR) alerts, follow-up testing, and patient navigation systems in order to increase the number of baby boomers who are screened and, if needed, treated for Hepatitis C. In the three years since the program was introduced, thousands of eligible Parkland patients have been tested for the virus, and several hundred have been navigated to treatment.

“We’re putting about 45 to 50 patients with Hep C on treatment a month,” Jain says.

Now her research team works on expanding the Parkland screening and treatment system to other sites around the Dallas-Fort Worth metroplex, and particularly to the rural areas in Tarrant County, where many baby boomers at high risk for the disease live.

In addition to the EMR alerts and follow-up screenings, Jain’s team has also developed educational materials for both patients and healthcare providers.

“We’re focusing on increasing Hepatitis C treatment, and the way to increase that treatment is to train more doctors to provide those treatments,” she explains. “But you also have to get the patients interested.”

Although this multi-faceted approach to providing care to Hepatitis C patients in the Dallas area has been effective, Dr. Jain’s team realized that there was one patient population the project was missing.

“Because I am an HIV physician, I found that we had all these patients with HIV booked for appointments in the Hepatitis C clinic who wouldn’t show up,” she says. “They just kept showing up at the HIV clinic.”

That realization led her to develop Eradicate HCV, a project that concentrates on increasing HIV patients’ access to Hepatitis C treatment. Though still at an early stage in the planning and funding process, the project draws heavily from the successes of Parkland’s previous efforts.

Like the project to increase screening for baby boomers, Eradicate HCV incorporates provider education, EMR screening alerts, and patient navigation to link co-infected HIV/Hepatitis C patients to treatment. But the emphasis is a little different. Rather than training primary care doctors to screen for Hepatitis C, Eradicate HCV aims to teach HIV doctors to walk with their patients through every stage of treatment.

“These patients don’t want to go to someone different from their HIV doctors,” Dr. Jain explains. “And the truth is that these treatments have become so easy that we can train HIV doctors and primary care providers to use these drugs, and that’s our goal – to train them and therefore increase the number of HIV patients treated.”

Like all of the Hepatitis C treatment initiatives Dr. Jain leads, Eradicate HCV will also include nurses and pharmacists who work with patients, insurance companies, drug manufacturers, and assistance programs to fund the treatment and medication plans.

“It’s definitely possible to get patients treated,” Dr. Jain says. “You just have to have the will and some coordination.”